| NPI | 1053576033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CO DR.0056803) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD60234837) |
| Enumeration Date | 2008-07-18 |
| Last Update Date | 2017-11-09 |